World Campus International, Inc.
 Dai 2 Ebisu Heights #101
4-17-8 Ebisu
Shibuya-ku, Tokyo 150-0013
Japan

To Contact Us in Japanese:
Phone: Japan: +81 3 3473 1120
Fax: +81 3 5475 5842
Email: hyasui@worldcampus.org

To Contact Us in English:
Phone: USA: +1 303 495-2078
Toll free in the USA and Canada:
+1 866 595-6323
Fax: +1 303 495-2069
Email: rsloat@worldcampus.org

Please Complete and Send the Following Information to Submit your Application. (*indicates optional fields)


ATTENTION: Upon completion of your application, please
email Robert Sloat at rsloat@worldcampus.org to confirm
that your submitted application has been received.
Thank you!

1. Personal Information

First Name
*Middle (if applicable)
Last Name
*Nickname or Name that you Prefer to be Called
Birth Date (mm/dd/yyyy)
Email Address
*Skype Address
Full Address as Written for International Mail
      Address Valid until When?

Permanent Residential Address
(if different from above)

Home Phone with Country and City Codes
Mobile Phone with Country and City Codes
Country / Countries to which you Hold a Passport
Birth Country
Country you Wish to Represent on Tour
Gender: Male Female
What Ethnicity do you Consider yourself?
2. Education, Profession & Language:
Please Describe your Most Recent Completed Level of Education
Are you Currently Enrolled at a College or University? (if no, please skip to the highlighted section below) Yes No
Please Describe the Nature of your Studies and Intended Degree upon Graduation

What is the Name and Full Address of your College or University?
Please Provide a Phone Number and / or Web or Email Address for your School
Do you Plan to Seek Academic Credit with your School for your P articipation in our Program?
If you are not in College/University,  Please Describe your Current School, Job or Profession

What is the Name and Full Address of your Current School or Employer?
Please Provide a Phone Number and / or Web or Email Address for your School or Employer
Native Language
Additional Language
Written  Fluency: High Moderate Low
Spoken  Fluency: High Moderate Low
Additional Language
Written  Fluency: High Moderate Low
Spoken  Fluency: High Moderate Low
Additional Language
Written  Fluency: High Moderate Low
Spoken  Fluency: High Moderate Low
Additional Language
Written  Fluency: High Moderate Low
Spoken  Fluency: High Moderate Low
3. Programs
Which Program are you Applying for?  
Japanese Spring 2009 Programs
more than one Program:
        		 Kansai Area:
        March 9th – March 23rd
Kanto Area:
        March 26th – April 9th		 Kyusyu Area:
        April 12th – April 26th
Have you Applied to Travel with  World Campus International, Inc.  Before? Yes No
If Yes, Please State Which Program you had Applied for
Please Describe how you First Heard about World Campus International?
4. Recommendation Contact Information

Please list the name of an English speaking, non-relative who will act as your recommendation.  World Campus International reserves the right to decide whether or not to contact this person.
Full Name
Gender
E-mail Address
Telephone Number with Country and City Codes
Available Times to be Reached
What is your Relationship to this Person?
How Long have you Known this Person?
5. Volunteerism, Community Involvement Activities or Awards received:

Please provide a short description and dates of involvement or when you received awards.
6. Please describe in the space provided below the following:
  1. What do you believe you will gain from attending this program?
  2. What can you contribute to make the experience the best it can be for both your fellow participants and the communities on tour?
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JapaneseLegal Terms
World Campus International, Inc. copyright 2007-2008. All rights reserved.